ABSTRACT

Objective: The use of pre-drilled pilot holes to accurately place and fix anterior cervical plates (ACP) is not established in the literature. Despite the usefulness of ACP after anterior cervical discectomy and fusion (ACDF), there remain challenges to their precise placement and alignment, which could encroach and affect the adjacent level. Authors describe a technique of the precise placement of the shortest available ACP after one-level ACDF.

Methods: Technique description is given. Data were collected based on a retrospective review of 330 medical records from patients who underwent one-level ACDF with ACP fixation for various conditions. Patients who had ACP placed using the pre-drilled pilot hole technique were assigned to Group 1 and those who underwent traditional ACP fixation with the pilot holes drilled through the plates were assigned to Group 2. Lengths of ACP, heights of interbody cages and estimated blood loss were reviewed.

Results: Groups 1 included: 175 patients, Group 2 included: 155 patients.  Mean age at surgery was 49.7 years (range 29–66 years) with no difference between groups (p = 0.85).  There was no difference in gender distribution between groups (56% female), between body mass indices (p = 0.06), or smoking status reported (p = 0.45).  We found that Group 1 utilized smaller plate sizes (5–16 mm) compared with Group 2 (17–23 mm). Mean cage sizes in Groups 1 and 2 were not different.

Conclusions: A pre-drilled pilot hole technique for placement of ACP after ACDF offered a reliable way to safely secure the smallest plate available at surgery when compared with measuring a plate then placing the pilot hole through the plate.